分级诊疗护理模式在Wagner 0级糖尿病足高危患者中的应用  

Application of a tiered care system for high-risk patient with Wanger grade 0 diabetic foot

作　　者：胡颖[1] 刘悦 张琦[1] 包冉[1] 路婷婷 方芳[1] Hu Ying;Liu Yue;Zhang Qi;Bao Ran;Lu Tingting;Fang Fang(Department of Endocrinology,Shanghai First People's Hospital,Shanghai,200080,China)

机构地区：[1]上海市第一人民医院内分泌科,上海200080

出　　处：《现代临床护理》2021年第6期31-36,共6页Modern Clinical Nursing

基　　金：上海交通大学医学院护理科研重中之重项目,项目编号为Jyhz1802;上海市护理学会科研课题面上项目,项目编号为2018MS-B06。

摘　　要：目的探讨对Wagner 0级糖尿病足高危患者分级诊疗护理模式在糖尿病足高危患者中的应用。方法采用便利抽样的方法,选取2019年9月至2020年9月于上海市某社区卫生服务中心随访的200例Wagner 0级糖尿病患者为研究对象,并实施分级诊疗护理模式。干预6个月后比较干预前后评估患者足部风险分级、足部护理相关知识与行为状况、自我管理能力及下肢动脉血供等指标变化。结果干预前后患者均未发生糖尿病足溃疡。干预后患者糖尿病足危险等级较干预前轻;干预后糖尿病患者下肢动脉血供的踝肱指数均高于干预前;干预后糖尿病高危足患者足部护理相关知识与行为状况得分高于干预前;干预后糖尿病高危足患者足部护理相关知识与行为状况得分高于干预前;干预后糖尿病高危足患者饮食控制、血糖监测、运动行为、用药行为和足部皮肤管理等自我管理行为评分均高于干预前,前后比较,差异具有统计学意义(均P<0.05)。结论在分级诊疗护理联动体系下,分层诊疗护理模式可延缓Wagner 0级糖尿病足患者的进展,有效提升社区糖尿病足综合防治能力。Objective To construct a tiered care system for patients with high-risk Wanger grade 0 diabetic foot and investigate the effect of the care system.Methods A random sampling method was used to select 200 patients with Wagner grade 0 diabetic foot.The patients were reviewed at a community health centre in Shanghai for 12 months from September 2019 to September 2020 as the research objects for a tiered care system.The tiered care system was applied for 6 months.The risk classification of the foot,foot care-related education,patient behaviour,self-management ability,and arterial blood supply of lower limb were compared before and after the intervention.Results All patients did not develop diabetic foot ulcers before and after intervention.The risk level after intervention was lower than that before intervention.In comparison with pre-intervention,the ankle brachial index of anterial blood supply for lower limbs and the scores of foot care-related knowledge and behaviour was higher,and there were significantly higher scores in diet control,sugar monitoring,exercise,medication and foot skin care after the intervention(all P<0.05).Conclusions Under the hierarchical diagnosis,the tiered care system for diabetic foot can delay the progress of Wagner grade 0 diabetic foot.It effectively and comprehensively improves the capabilities in prevention and treatment of diabetic foot in community healthcare services.

关 键 词：分级诊疗 糖尿病足 护理模式 

分 类 号：R473.5[医药卫生—护理学]